Presence of incomplete superficial axillary arch and pectoralis quartus muscle in one male body / Presencia en un individuo de un arco axilar superficial incompleto y de un músculo pectoral cuarto

SUMMARY: The anatomical variations of the pectoralis major muscle (PMM) and latissimus dorsi muscle (LDM) range from agenesis to the presence of supernumerary fascicles with a variety of insertions and relationships with the muscles, fascia, vessels, nerves and skeletal components of the shoulder girdle and the axilla. Many of these variations are clinically irrelevant, but extremely interesting and revealing from the perspective of comparative anatomy, ontogeny, and phylogeny. In this report, we present two different supernumerary muscles in the chest of one adult male body, identified during dissection practice of undergraduate medical students at Universidad Surcolombiana. These supernumerary fascicles in the axillary region were caudal to the lower edge of the PMM on the right side of the chest, and in contact with the anterior edge of the LDM on the left side of the chest; each fascicle was inserted in the ipsilateral coracoid process. These observations are congruent with the pectoralis quartus muscle and an incomplete and superficial axillary arch, respectively.

RESUMEN: Las variaciones anatómicas del músculo pectoral mayor (MPM) y del músculo latísimo del dorso (MLD) van desde la agenesia hasta la presencia de fascículos supernumerarios con una variedad de inserciones y relaciones con los músculos, fascias, vasos, nervios y componentes esqueléticos de la cintura escapular y la axila. Clínicamente, muchas de las variaciones son irrelevantes, pero extremadamente interesantes y reveladoras desde la perspectiva de la anatomía comparada, la ontogenia y la filogenia. En este estudio, presentamos dos músculos supernumerarios diferentes en la pared torácica de un hombre adulto, identificados durante la práctica de disección de estudiantes de medicina de la Universidad Surcolombiana. Estos fascículos supernumerarios en la región axilar estaban caudales al margen inferior del MPM en el lado derecho del tórax y en contacto con el margen anterior del MLD en el lado izquierdo del tórax; cada fascículo se insertaba en el proceso coracoides ipsilateral. Estas observaciones son congruentes con el músculo pectoral cuarto y un arco axilar incompleto y superficial, respectivamente.

Expresión morfológica del músculo axilopectoral: un estudio anatómico directo en una muestra de población colombiana / Morphological expression of the axillary pectoral muscle: a direct anatomical study in a sample of Colombian population

El músculo axilopectoral (MAP) es una estructura fibromuscular accesoria de la región axilar, que se relaciona con el plexo braquial, vasos y linfonodos axilares, y es reportado en los diferentes grupos poblacionales con incidencia variable. Se evaluaron un total de 106 axilas correspondientes a 53 cadáveres frescos que fueron sometidos a autopsia. El MAP se presentó en 5 regiones axilares (4,7 %), con tres casos unilaterales (2,8 %) y uno bilateral (0,9 %). La longitud total del MAP estuvo en un rango de 81,6-119,7 mm, mientras que su segmento tendinoso midió 13,3-28,1 mm. El espesor de su vientre muscular fue de 7,1-52 mm y del tendinoso 6,920,1 mm. En todos los casos, el MAP se originó del músculo latísimo del dorso y se insertó en el labio lateral del surco intertubercular del húmero, adyacente a la inserción del músculo pectoral mayor. Los MAP evaluados fueron inervados por el nervio toracodorsal. En dos casos, el vientre muscular del MAP cursó con trayectoria antero medial a las fibras infraclaviculares del plexo braquial, mientras que en los tres restantes, los segmentos fibrosos de inserción del MAP estuvieron relacionados con el plexo. La incidencia del MAP encontrada en el presente estudio es similar a los reportes previos realizados en cadáveres y considerablemente mayor a los reportes anatomoquirúrgicos. La importancia del MAP radica en su implicación con el síndrome de salida torácica, trombosis profunda del miembro superior y en las complicaciones en la linfadenectomía axilar.

The axillary pectoral muscle (APM) is an accessory fibromuscular structure of the axillary region. It is related to the brachial plexus, axillary vessels and lymph nodes, and is reported with variable incidence in different population groups. A total of 106 axilla were evaluated corresponding to 53 fresh cadavers. The APM was presented in 5 axillary regions (4.7 %), with three unilateral cases (2.8 %) and one bilateral (0.9 %). The total length of the APM ranged from 81.6-119.7 mm, while its tendinous segment measured 13.3-28.1 mm. Muscular belly thickness was 7.1-52 mm and the tendinous segment measured 6.9-20.1 mm. In all cases, the APM originated from the latissimus dorsi muscle and inserted into the lateral lip of humerus intertubercular sulcus, adjacent to the pectoralis major muscle insertion. The evaluated APMs were innervated by the thoracodorsal nerve. In two cases, the APM muscular belly had an anterior medial trajectory to brachial plexus fibers, while in the remaining samples, long fibrous segments of APM insertion were related to the plexus. The incidence of the APM found in the present study is similar to previous reports carried out in cadavers; it was considerably higher than previous anatomy-surgical reports. The importance of APM relies on its involvement with thoracic outlet syndrome, deep thrombosis of the upper limb and complications in axillary lymphadenectomy.

Incidence of sternalis muscle in the Caldas population (Colombia): anatomical variations / Incidencia del músculo esternal en la población de Caldas (Colombia): variaciones anatómicas

The musculus sternalis is an anatomical variant that occurs in 3-8 % of the world population and its incidence is higher in women. It can be found unilaterally or bilaterally and is located in the anterior wall of the thorax, where its fibers run parallel to the sternum and superficial to the medial part of the pectoralis major muscle. The main objective of this study was to quantify the incidence of musculus sternalis in the population of Caldas (Colombia) and, therefore, 68 cadavers of adult individuals were used during a period of twenty years to determine the incidence of this muscle and describe its anatomical characteristics. Two cadavers had this muscle, which was equivalent to 2.94 % of the sample, where one was located unilaterally and in other bilaterally. In the case of unilateral presence, the muscle presented an oblique direction thatdoes not coincide with any subtype of the classification given for these muscles. In bilateral presentation, both muscles were continuous at their upper ends with the respective sternocleidomastoid muscle. In addition, the right musculus sternalis had a digastric shape, which also does not coincide with any subtype of the classification.

El músculo esternal es una variante anatómica que se presenta entre el 3 % y 8 % de la población mundial y su incidencia es mayor en mujeres. Puede hallarse de manera unilateral o bilateral y se localiza en la pared anterior del tórax, donde sus fibras corren paralelas al esternón y superficial a la región medial del músculo pectoral mayor. El objetivo del presente estudio fue cuantificar la incidencia del músculo esternal en la población de Caldas (Colombia). Fueron revisados 68 cadáveres de individuos adultos durante un lapso de doce años, con el fin de determinar el grado de presencialidad del músculo y sus características anatómicas. Dos cadáveres, que equivale al 2,94 % de la muestra, presentaron el músculo esternal, uno de manera unilateral y el otro bilateral, a los cuales se les hizo una descripción anatómica detallada. En la presentación unilateral, el músculo presentó una dirección oblicua que no coincide con ningún subtipo de la clasificación dada para estos músculos. En la presentación bilateral, ambos músculos se continúan por su extremo superior con el respectivo músculo esternocleidomastoideo. Además, el músculo esternal derecho tiene una configuración digástrica, que tampoco coincide con ningún subtipo de la clasificación.

Description of the chondroepitroclearis muscle and its relationship to the median nerve in a Korean corpse / Descripción del músculo condroepincondilar medial y su relación con el nervio mediano en un cadáver coreano

SUMMARY: Anomalous muscle slips of pectoralis major have been reported on several cases in the literature. Among these, chondroepitroclearis muscle is an extremely rare aberrant muscular slip originating from the pectoral region. During an educational dissection, chondroepitroclearis muscle was found on the right side in a Korean cadaver. Tendinous muscular slip originated from pectoralis major muscle, crossing the neurovascular bundle in the arm, and inserted onto medial epicondyle of the humerus. Clinical significance of these anomalous slip can cause median nerve entrapment and functionally limited movement of the humerus. We report a case of tendinous chondroepitroclearis muscle and discuss its clinical and embryological significance.

RESUMEN: En la literatura se han reportado fascículos anómalos del músculo pectoral mayor. Entre estos, el condroepicondilar medial es un fascículo muscular aberrante extremadamente raro que se origina en la región pectoral. Durante una disección educativa, se encontró esta variación en el lado derecho de un cadáver coreano. El fascículo muscular tendinoso se originó a partir del músculo pectoral mayor, cruzando el paquete neurovascular en el brazo, y se insertó en el epicóndilo medial del húmero. La importancia clínica de estos fascículos anómalos radica en la posibilidad de causar el atrapamiento del nervio mediano, causando un movimiento funcionalmente limitado del húmero. Divulgamos un caso de músculo condroepicondilar medial tendinoso y discutimos su significado clínico y embriológico.

Muscle thickness of the pectoralis major and rectus abdominis and level of physical activity in chronic hemodialysis patients / Espessura muscular do pectoralis major e do rectus abdominis e nível de atividade física em pacientes em hemodiálise crônica

Abstract Introduction: Patients on chronic hemodialysis tend to lose lean body mass and have sedentary behavior. Objective: To compare the level of physical activity and the morphology of the muscles pectoralis major and rectus abdominis of patients on hemodialysis with healthy subjects. Methods: We studied 17 patients and 17 healthy individuals. Muscle thickness were evaluated by ultrasound, and the level of physical activity by the International Physical Activity Questionnaire (IPAQ), long version. Results: The patients had lower thicknesses of the pectoralis major (5.92 ± 0.35 mm vs. 8.35 ± 0.62 mm, p < 0.001) and rectus abdominis (0.96 ± 0.10 mm vs. 2 21 ± 0.40 mm, p < 0.001) compared to healthy subjects. Patients were physically less active than healthy individuals: 1502.55(788.19-2513.00) MET-minutes/week vs. 2268.0(1680.0-4490,8) MET-minutes/week (p = 0.006); the weekly caloric expenditure of patients was also lower: 1384.0(480,7-2253.7) kcal/kg/week vs. 1680.0(1677.4-4950.0) kcal/kg/week (p = 0.010). The average time spent sitting per week of the patients was higher than in healthy subjects (394.0 ± 33.1 min/day vs. 293.0 ± 38.6, p = 0.009) as well as the average time spent sitting during weekend (460.0 ± 40.1 vs. 201.0 ± 10.7, p = 0.003). Conclusion: Chronic renal failure patients on hemodialysis have sedentary behavior and lower muscle thickness of the trunk.

Resumo Introdução: Pacientes que realizam hemodiálise crônica tendem a perder massa magra e ter comportamento sedentário. Objetivo: Comparar o nível de atividade física e morfologia dos músculos peitoral maior e reto do abdômen de pacientes que realizam hemodiálise com indivíduos saudáveis. Métodos: Foram estudados 17 pacientes e 17 indivíduos saudáveis. As espessuras musculares foram avaliadas por meio de ultrassonografia, e o nível de atividade física pelo Questionário Internacional de Atividade Física versão longa (IPAQ). Resultados: Os pacientes apresentaram menores espessuras do peitoral maior (5,92 ± 0,35 mm vs. 8,35 ± 0,62 mm, p < 0,001) e de reto abdominal (0,96 ± 0,10 mm vs. 2,21 ± 0,40 mm, p < 0,001) comparados aos sujeitos saudáveis. Os pacientes foram fisicamente menos ativos que os indivíduos saudáveis: 1502.55(788.19-2513.00) MET-minutos/semana vs. 2268.0(1680.0-4490,8) MET-minutos/semana (p = 0,006); o gasto calórico semanal dos pacientes também foi menor: 1384,0(480,7-2253.7) kcal/kg/semana vs. 1680,0(1677,4-4950,0) kcal/kg/semana (p = 0,010). O tempo médio gasto sentado por semana dos pacientes foi maior que dos sujeitos saudáveis (394,0 ± 33,1 min/dia vs. 293,0 ± 38,6, p = 0,009), assim como o tempo médio gasto sentado durante o fim de semana (460,0 ± 40,1 vs. 201,0 ± 10,7, p = 0,003). Conclusão: Pacientes renais crônicos em hemodiálise apresentam comportamento sedentário e menores espessuras musculares do tronco.

Muscular anatomy of the pectoral girdle and forelimb of Iguana i. iguana (Squamata: Iguanidae) / Anatomia muscular do cíngulo peitoral e membro torácico de Iguana i. iguana (Squamata: Iguanidae)

Green iguana has arboreal and terrestrial habits. It is widely distributed in Central and South America, inhabiting several biomes in Brazil. Some researches were focused on this species, however, morphological information are still limited. With that in sight, we aimed to add data to the anatomical knowledge. Two post mortem specimen of Iguana i. iguana were acquired, donated by a scientific breeding, and dissected. To describe the muscles we refuted the skin and removed the fascias, individualizing the muscles. We identified the following muscles: pectoralis, deltoideus clavicularis, deltoideus scapularis, trapezius, latissimus dorsi, coracobrachialis brevis, coracobrachialis longus, serratus thoracis, levator scapulae, biceps brachii and triceps brachii. Some of them, like coracobrachialis brevis, present conservative anatomy, originating from the ventral surface of the coracoid and inserting onto the proximal humerus. Some, like trapezius and biceps brachii, are similar to other reptile species, trapezius takes its origin from the thoracodorsal fascia and biceps arises by two heads and inserts on the radial tuberosity. Deltoideus clavicularis and deltoideus scapularis share a common insertion tendon. Pectoralis varies its origin and divisions, however, the insertion always occur on the deltopectoral crest. Triceps brachii is comprised of four heads. Its long medial head originates via a tendinous arc, feature described only in crocodilians. We conclude that Iguana i. iguana forelimb musculature is similar to other reptiles, presenting its own characteristics that reflect its habits.

Iguanas verdes tem hábitos arbóreos, terrestres e aquáticos, e são totalmente herbívoras. Tem ampla distribuição na América Central e do Sul, habitando vários biomas no Brasil. Investigações diversas tiveram esta espécie como foco, embora informações morfológicas sejam ainda escassas. Objetivando adicionar dados ao conhecimento anatômico, dois espécimes de Iguana i. iguana foram obtidos post mortem, por doação de um criadouro científico, e dissecados. Os músculos foram individualizados para identificação e descrição das origens, inserções e características. Alguns músculos, como o coracobraquial curto, apresentam morfologia conservativa, sua origem ocorre na superfície ventral do coracóide e inserção na epífise proximal do úmero. O trapézio, o bíceps braquial e o deltóide clavicular se apresentam similares à outros répteis, com a origem do trapézio na fáscia toracodorsal e o bíceps, com duas cabeças, se inserindo no tubérculo do rádio. O deltóide clavicular possui o tendão de inserção unido ao do músculo deltóide escapular. O músculo peitoral apresenta variações em sua origem e divisões, mas a inserção sempre ocorre na crista deltopeitoral. A origem da cabeça longa caudal do tríceps ocorre por meio de arco tendíneo, característica antes descrita apenas em crocodilianos. A musculatura de Iguana i. iguana se apresenta similar à de outros répteis no geral, com características próprias refletindo seus hábitos.

Miologia do membro torácico da paca (Cuniculus paca) / Miology of the forelimb of paca (Cuniculus paca)

Objetivou-se descrever os músculos do membro torácico da paca (Cuniculus paca Linnaeus, 1766), mediante dissecação anatômica dessa região. Foram utilizadas cinco Cuniculus paca adultas, machos e fêmeas, pesando entre cinco e 10kg do plantel de pacas do setor de Animais Silvestres da FCAV, Unesp, Jaboticabal/SP. Os animais foram fixados em formoldeído a 10% e conservados em solução salina a 30% para dissecação anatômica da musculatura do ombro, braço e antebraço, identificando-se a origem e inserção de cada músculo. Os resultados foram fotodocumentados e discutidos com base na literatura sobre animais domésticos, ratos e cobaias. Salvo algumas variâncias na origem e inserção de cada músculo e na fusão dos ventres de alguns grupos musculares, de forma geral, a musculatura do ombro, braço e antebraço da paca assemelha-se a dos animais domésticos e a de outros roedores.

The objective was to describe the forelimb muscles of paca (Cuniculus paca Linnaeus, 1766), by anatomical dissection of this region. Five adult male and female C. paca, weighing 5-10kg, from the Department of Wild Animals, FCAV-Unesp, Jaboticabal/SP, were used. The animals were fixed in formaldehyde 10% and stored in saline 30% for anatomic dissection of the muscles of shoulder, arm and forearm, identifying the origin and insertion of each muscle. The results were photodocumented and discussed based on the literature of domestic animals, rats and guinea pigs. Unless some variances in the origin and insertion of each muscle and fusion of bellies of some muscle groups, in general, the muscles of shoulder, arm and forearm of paca resemble the ones of domestic animals and other rodents.

Variante anatómica supernumeraria del músculo pectoral mayor (tercer pectoral) / Supernumerary anatomical variant of pectoralis major muscle (third pectoral)

INTRODUCCIÓN: existen estudios que describen variantes anatómicas definidas y frecuentes en el poblador Andino Boliviano, en el aparato locomotor pedio y la constancia del Músculo tercer abductor, entre otros. ¿Por qué no en cualquier otro segmento? Las variaciones del Músculo pectoral mayor no suelen ser encontradas con frecuencia en la literatura. MATERIAL Y MÉTODO: se estudiaron 2 cadáveres adultos varones de características; raza mestiza del altiplano Boliviano, edades aparentes entre 30 y 70 años, conservados con solución de Formaldehido al 15% en el Pabellón Florentino Mejía del Departamento de Ciencias Morfológicas de la Facultad de Medicina de la Universidad Mayor San Andrés. El estudio se llevó a cabo en dos gestiones consecutivas. Se realizó la técnica de disección convencional topográfica regional, de las regiones pectoral, axilar y braquial. RESULTADOS: dos preparaciones presentaron la misma variante en la región axilar izquierda. En ambos casos, la estructura muscular bien diferenciada, debajo del pectoral mayor, se originaba en la unión condrocostal de la 6ta y 7ma costilla, tomando un trayecto supero lateral, paralelamente al borde lateral del pectoral Mayor y se insertaba en el borde medial del tabique medial del brazo. CONCLUSIÓN: se trata de una variante del Músculo Pectoralis Tertius o Tercero, que se considera así a todo aquel fascículo supernumerario del músculo pectoral Mayor, con un origen e inserción independiente de él. Empero la descripción del hallazgo no corresponde cabalmente a ninguna mencionada en la literatura revisada. Corresponde a un fascículo supernumerario o músculo no descrito hasta la fecha.

INTRODUCTION: studies describing frequent anatomical variants defined in the Bolivian Andean settler in the locomotion pedal and constancy third abductor muscle, among others. Why not in any other segment? The muscle Pectoralis major's variations usually not often found in the literature. MATERIAL AND METHOD: 2 male adult cadavers were studied characteristics; half blood from Bolivian altiplano apparent ages between 30 and 70 years, preserved with formaldehyde solution 15% in Block Florentino Mejia Morphological Sciences Department of the Faculty of Medicine of the Universidad Mayor San Andrés. The study was conducted in two consecutive steps. The conventional technique of regional topographical dissection of the chest, axillary and brachial regions was performed. RESULTS: two preparations had the same variant in the left axillary region. In both cases, the distinct muscular structure beneath the pectoralis major, originated in the costochondral junction of the 6th and 7th rib, taking a trip surpassed side, parallel to the lateral edge of the pectoralis major and was inserted into the medial edge of the partition medial arm. CONCLUSION: this is a variant of the Pectoralis Tertius Muscle or third, so that everyone sees the pectoral muscle bundle temporary Mayor, with a separate origin and insertion of it. But the description of the find does not correspond fully to any mentioned in the literature reviewed. It corresponds to a temporary issue or muscle not described to date.

The pectoralis major footprint: An anatomical study / Footprint do tendão do peitoral maior: estudo anatômico

Objective: To study the insertion of the pectoralis major tendon to the humerus, through knowledge of its dimensions in the coronal and sagittal planes. Methods: Twenty shoulders from 10 cadavers were dissected and the pectoralis major tendon insertion on the humerus was identified and isolated. The dimensions of its "footprint" (proximal to distal and medial to lateral borders) and the distance from the top edge of the pectoralis major tendon to apex of the humeral head structures were measured. Results: The average proximal to distal border length was 80.8 mm (range: 70 -90) and the medial-to-lateral border length was 6.1 mm (5 -7). The average distance (and range) from the apex of the pectoralis major tendon to the humeral head was 59.3 mm. Conclusions: We demonstrate that the insertion of the pectoralis major tendon is laminar, and the pectoralis major tendon has an average footprint height and width of 80.8 mm and 6.1 mm, respectively. .

Objetivo: Estudar a inserção do tendão do peitoral maior no úmero, por meio do conhecimento de suas dimensões nos planos coronal e sagital. Métodos: Foram dissecados 20 ombros de dez cadáveres frescos (cinco homens e cinco mulheres). Todos os cadáveres encontravam-se em bom estado, sem cicatrizes ou sinais de trauma prévios. Fez-se o estudo por meio da via deltopeitoral estendida e foi identificada e isolada a inserção do tendão do peitoral maior no úmero. Mensuraram-se as dimensões do footprint por meio das aferições com um paquímetro milimetrado, de seus limites de proximal para distal e medial para lateral. Foi aferida a distância da borda superior do tendão do peitoral maior ao ápice da cabeça umeral. Resultados: Em todos os cadáveres o peitoral maior apresentou uma inserção única. O comprimento médio de proximal para distal foi de 80,8 mm (70-90) e de lateral para medial de 6,1mm (5-7). Já a distância média do ápice do tendão do peitoral maior ao ápice da cabeça umeral foi de 59,3 mm (55-64). Conclusões: O tendão do músculo peitoral maior apresenta inserção laminar. O footprint tem a altura e a largura média de 80,8 mm e 6,1 mm, respectivamente. .

Tendón de inserción del pectoral menor (Pectoralis Minor): una variante a tener presente / Pectoralis minor tendon insertion: a variant to keep in mind

Introducción: A pesar de más de un siglo de la descripción inicial de la existencia de múltiples variaciones de la forma e inserción de los músculos pectorales; el avance tecnológico y las novedosas técnicas quirúrgicas, obligan a la comunicación y a reflotar dichas variedades con el fin de alertar sobre su existencia. Material y Métodos: Disección simple de 12 piezas formolizadas individuales, aisladas y observación de 39 especímenes óseos secos. Resultados: Fue encontrada una variación en la inserción proximal del pectoral menor a nivel de la apófisis coracoidea de la escapula, en un hombro derecho, la cual presenta una serie de particularidades que serán objeto de esta publicación. Relevancia Clínica: Tener en cuenta la presencia de estas variaciones tendinosas en la cercanía del intervalo de los rotadores, su íntima vinculación con el ligamento coracohumeral y el tendón del supraespinoso, junto con la presencia de una bolsa serosa epicoracoidea; es suficiente para alertar sobre la posible causa de síndromes dolorosos inespecíficos de la región. Comprender la anatomía regional frente a la aparición de estas variaciones durante un procedimiento quirúrgico. Por otro lado, entrenar y agudizar al ojo del especialista en imágenes para aumentar su capacidad diagnóstica y no malinterpretar los resultados de los estudios ecográficos y de resonancia magnética

Langer’s muscular axillary arch, features and importance.

Anatomical variations are common in axilla. These are usually encountered during axillary explorations for breast cancer and other surgical procedures. The most common being the presence of a muscular slip known as the axillary arch. This muscle, usually arises from the latissimus dorsi to be attached to the pectoralis major (which is more common) or to the coracobrachialis or to the fascia over the biceps brachii. This may be single or present as multiple bands and may or may not be clinically apparent. The axillary arch may cause thoracic outlet syndrome like symptoms, may pose difficulty in axillary explorations for various surgical procedures, reconstruction techniques and axillary bypass operations. The current case report is to discuss the features of this variation, with an emphasis on its surgical implications.

The existence of axillary arch in human fetus and applied importance and clinical implications in the axillary brachial plexus blocks / La existencia de arco axilar en el feto humano y la importancia aplicadae implicancias clínicas en los bloques de plexo braquial

Axillary arch is the most common muscle variation of axillary fossa that gains importance for regional interventional procedures, screening methods and physical examination. In order to avoid malpractice the variations must be borne in mind. This study has been planned to research the frequency and the features of the axillary arch in human fetus, to mention the potential clinical and functional significance of axillary arch while applying axillary brachial plexus block and reflect on possible complications. Axillary fossa was examined with a stereomicroscope in 20 upper extremities of ten human fetuses. The gestation ages ranged from 16 to 36 weeks. Axillary arch was determined in 2/20 specimen unilaterally. In both specimen, muscular slip detached from latissimus dorsi, passed anterior neurovascular bundle and ended posterior pectoralis major tendon and lateral border of intertubercular groove. In one specimen axillary arch was innervated with medial pectoral nerve whereas the other one did not have a particular innervating nerve branch. The possible effects of axillary arch in the axillary brachial plexus block applications are discussed. Arcus axillaris may have a potential clinical and functional significance with regard the axillary brachial plexus block applications and may have possible effects on failure rate and acute complications. Also, we think that this fetus study which the pure structure of the muscles without any usage effect can be observed will be beneficial regarding this topic.

El arco axilar es la variación muscular más común de la fosa axilar, siendo de importancia para la región en los procedimientos de intervención, los métodos de selección y el examen físico. Con el fin de evitar las negligencias se debe tener en cuenta las variaciones. El objetivo de este estudio fue determinar la frecuencia y las características del arco axilar en el feto humano. Es necesario mencionar la importancia del potencial clínico y funcional del arco axilar en la aplicación de bloqueo axilar del plexo braquial y sus posibles complicaciones. La fosa axilar fue examinada bajo microscopio estereoscópico en 20 miembros superiores de diez fetos humanos. La edad de gestación varió de 16 a 36 semanas. El arco axilar se observó unilateralmente en 2/20 especímenes. En ambos especímenes el músculo cruzó anteriormente el paquete neurovascular y terminó en el tendón del músculo pectoral mayor y en el margen lateral del surco intertubercular. En un especimen el arco axilar se encontraba inervado por el nervio pectoral medial, mientras que en el otro no existía una determinado ramo del nervio. Se discuten los posibles efectos del arco axilar en las aplicaciones de bloqueo axilar del plexo braquial. Puede tener un significado potencial clínico y funcional, en lo que se refiere a la aplicación de bloqueo axilar del plexo braquial y aademás producir efectos de complicaciones agudas.

Electromyographic validation of the deltoid (anterior portion) and pectoralis major (clavicular portion) in military press exercises with open and middle grips

The deltoid (anterior portion) and pectoralis major (clavicular portion) were evaluated in several execution ways of military press exercises with open and middle grips in order to know their behavior pattern. It was analyzed 24 male volunteers, using a 2-channel TECA TE4 electromyograph and Hewllet Packard surface electrodes. It was observed that the execution variation with open and middle grips does not present any significant difference as for the demanding level neither for the pectoralis major muscle nor the deltoid muscle.

Costodorsalis ­ an Additional Slip of Pectoralis Major Muscle: a Case Report / Costodorsal ­ un Fascículo Adicional del Músculo Pectoral Mayor: Reporte de un Caso

Occurrence of variant muscular slips from pectoralis major muscle is rare. In this report, we present a rare case of aberrant muscular slip associated with the pectoralis major muscle which we call costodorsalis. This muscular slip originated from the 6th rib near the costochondral junction and ran along the lower border of pectoralis major muscle. It crossed the axilla from medial to lateral side and merged with the latissimus dorsi muscle. This type of origin and insertion is unique and has not been reported earlier. The knowledge of this muscle variation may be of special importance to the anesthesiologists, physiotherapists and plastic surgeons.

Es poco frecuente la aparición de variaciones de un fascículo muscular desde el músculo pectoral mayor . En este trabajo, presentamos el caso de un fascículo muscular aberrante asociado con el músculo pectoral mayor que denominamos costodorsal. Este fascículo muscular se originó en la 6 costilla cerca de la unión costocondral y corrió a lo largo del margen inferior del músculo pectoral mayor. Cruzó la axila de medial a lateral y se fusionó con el músculo latísimo del dorso. Este tipo de origen y la inserción es único y no se ha informado anteriormente. El conocimiento de esta variación muscular puede ser de especial importancia para los anestesistas, fisioterapeutas y cirujanos plásticos.

Análise da textura de músculos peitorais submetidos à fixação e conservação em álcool / Tenderness analysis of muscles fixed and kept in alcohol

A textura, ou maciez, pode ser avaliada pela mensuração da força necessária para ocorrer o cisalhamento das fibras musculares. Objetivou-se, nesse trabalho, a análise da textura de músculos submetidos à fixação e conservação em álcool, ao longo de um ano, mediante uso de um aparelho analisador de textura. Foram utilizados 48 peitos de frangos jovens, pesados, fixados e conservados em álcool etílico 96° GL. As análises foram realizadas após 15, 30, 90, 180 e 360 dias de conservação, além do grupo controle de músculos frescos. Os valores da força de cisalhamento dos diferentes grupos aumentaram progressivamente de 3,38 (grupo controle) até 15,31 Kgf (180 dias), caindo para 9,53 Kgf após 360 dias. Concluiu-se que quando músculos são submetidos à fixação e conservação em álcool 96° GL, ocorre diminuição da maciez, tornando-os quase cinco vezes mais rígidos ao corte após seis meses, e três vezes mais rígidos após um ano. Sugere-se que a dissecção de peças anatômicas musculares ocorra até 90 dias após fixação e conservação em álcool 96° GL ou ao redor de um ano nesse agente conservante, pois há menor rigidez tissular nesses períodos. Embora se tenha estudado o efeito do álcool na textura de tecido muscular de aves, acredita-se que, devido à grande homogeneidade tissular neste caso, tais dados possam ser extrapolados ou servir de base para estudos similares em outras espécies.

Texture, or tenderness, may be evaluated by measuring the force necessary to cause rupture of muscle fibers. The aim of this paper was to analyze the texture of muscles fixed and kept in alcohol, throughout a year, by using a texture analyzer. Forty eight poultry breasts were weighted, fixed and kept in a 96° GL ethylic alcohol solution. Analyses were performed at 15, 30, 90, 180 and 360 days of conservation, besides the one of the control group of fresh breasts. Values of shear forces of different groups increased progressively from 3.38 (control group) to 15.31 Kgf (180 days), decreasing to 9.53Kgf after 360 days. It was concluded that when muscles are fixed and kept in ethylic alcohol 96° GL the tenderness is decreased, becoming almost five times harder during the first six months and three times harder after a year. It is suggested that muscle anatomic pieces dissection occurs up to 90 days after fixation and conservation in 96° GL alcohol or around 1 year on this conservation product because there is smaller muscle stiffness in these times. Although the alcohol effect in texture of poultry muscle tissue has being studied in this paper, it is believed that, due this great tissue homogeneity, these data might be taken or being basis to similar studies in other species.

Cephalic vein: detail of its anatomy in the deltopectoral triangle / Vena cefálica: detalle de su anatomía en el trígono deltopectoral

The cephalic vein shows a scarce description, especially in the deltopectoral triangle, and its ending in the axillary vein. Some established considerations such as "superficial vein, located in the deltopectoral groove, accompanied by braches of the thoraco-acromial artery, which ends in the deltopectoral triangle in the shape of fan arch" should be reevaluated. Procedures difficulties in the la catheterization deserve for a more accurate description. A descriptive, prospective study is performed. The goal is to determine the anatomy of the cephalic vein in the deltopectoral triangle, with a special focus on the characteristics concerning its path and type of termination. Findings show that the cephalic vein is deeply placed and has a different path than that of an arch (circumference segment on a level) with a retro pectoral path and an acceptable diameter, thus useful and safe in the catheterization processes.

La vena cefálica ha sido poco descrita en el triángulo deltopectoral y su terminación en la vena axilar. Algunas consideraciones la señalan como "la vena superficial, situada en el surco deltopectoral, acompañada de ramas de la arteria toraco-acromial, que termina en el trígono deltopectoral en forma de arco de ventilador" por lo que debe ser reevaluado. Debido a las dificultades en los procedimientos de cateterización la vena cefálica merece una descripción más exacta. Se realizó un estudio descriptivo prospectivo con el objetivo de determinar la anatomía de la vena cefálica en el trígono deltopectoral, dando especial atención a sus trayecto y tipo de terminación. Los resultados demostraron que la vena cefálica está localizada profundamente en el surco deltopectoral, presenta un trayecto distinto a un arco (segmento de la circunferencia de un nivel) siendo este trayecto retropectoral y un diámetro aceptable, por lo tanto, útil y seguro para los procesos de cateterización.

Bilateral presence of axillary arch muscle passing through the posterior cord of the brachial plexus / Presencia bilateral del arco muscular axilar pasando por el fascículo posterior del plexo braquial

The axillary arch can be described as an anomalous muscular slip of latissimus dorsi muscle. In this paper, a rare case of bilateral axillary arch is reported during routine dissection of the axillary region of a 57-year old male cadaver. On both sides, the axillary arch muscle took origin from latissimus dorsi and teres major, and passed upwards through the posterior cord of the brachial plexus, but posterior to the bulk of axillary neurovascular bundle. It then split into two slips: the medial slip was inserted into the root of the coracoid process, while the lateral slip which was intracapsular, was attached to the lesser tubercle, above the attachment of subscapularis. The presence of the muscle has important clinical implications, and the position, bilateral presence, penetration of the posterior cord, and multiple connective tissue attachments makes the case most unique. The anatomy, surgical implications, and embryology of the anomalous muscle are discussed in this paper.

El arco axilar puede ser descrito como un fascículo muscular anómalo del músculo latísimo del dorso. En este trabajo, un raro caso de arco axilar bilateral se encontró durante la disección de rutina de la región axilar de un cadáver de 57 años de sexo masculino. En ambos lados, el músculo arco axilar se originó desde los músculos latísimo del dorso y redondo mayor y pasó hacia arriba a través del fascículo posterior del plexo braquial, pero posterior a la mayor parte del paquete neurovascular axilar. A continuación, se dividió en fascículos: el fascículo medial se insertó en la raíz del proceso coracoides, mientras que el fascículo lateral, era intracapsular y se insertaba en el tubérculo menor del húmero, por encima de la inserción del músculo subescapular. La presencia de este músculo axilar tiene importantes implicaciones clínicas, y la posición, la presencia bilateral, la penetración del fascículo posterior, y múltiples uniones de tejido conectivo hacen al caso más especial. La anatomía, las implicaciones quirúrgicas y embriología del músculo anómalo son discutidos en este trabajo.

Músculo esternal simulando nódulo mamário / Sternalis muscle simulating a breast nodule

OBJETIVO: relatar uma série de três casos de uma normal variation conhecida como músculo esternal simulando lesão mamária. MÉTODOS: a suspeita diagnóstica foi feita a partir do quadro clínico, achados no exame físico e aspectos de imagem, sendo confirmada por meio de métodos de imagem seccionais, como tomografia computadorizada (TC) e ressonância magnética (RM). Foi realizada uma revisão da literatura no banco de dados Medline e em livros-texto de radiologia mamária sobre os aspectos anatômicos, clínicos e de imagem do músculo esternal. RESULTADOS: três pacientes do sexo feminino, sem queixas, que apresentaram lesões mamárias de aspecto nodular na projeção dos quadrantes mediais (duas em exame mamográfico de rotina e uma em TC). O diagnóstico de músculo esternal foi confirmado por meio de RM de mamas ou TC de tórax, demonstrando imagem alongada, localizada na região paraesternal esquerda, adjacente ao músculo peitoral. CONCLUSÕES: o músculo esternal é uma variante não usual da musculatura da parede torácica, presente em cerca de 2 a 8 por cento da população. O conhecimento dessa entidade é fundamental, pois pode simular nódulo mamário.

PURPOSE: to report a series of three cases of a normal variation known as sternal muscle, simulating a breast lesion. METHODS: the diagnostic suspicion was based on the clinical picture, findings in the physical examination and imaging, being confirmed by sectional imaging methods such as computerized tomography (CT) and magnetic resonance imaging (MRI). A review of the literature has been made in the data Medline and in breast radiology textbooks about the anatomic, clinical and imaging aspects of the sternal muscle. RESULTS: three female patients, without complaints, who presented nodular breast lesions in the medial quadrants projection (two in a routine mammographic exam and one in a computerized tomography). The diagnosis of sternal muscle was confirmed through breast MRI or through thoracic CT, showing an elongated image in the left parasternal region, adjacent to the breast muscle. CONCLUSIONS: the sternal muscle is an unusual variation of the muscles of the thoracic wall, present in about 2 to 8 percent of the population. The knowledge of this entity is crucial, as it can simulate a breast node.

Anatomical and clinical considerations of the pectoralis tertius muscle in man / Consideraciones anatómicas y clínicas del músculo pectoral tercero en el hombre

The anatomical variation of the major pectoral muscles is infrequent, namely the agenesis of the pectoralis major muscle due to the morpho-functional alterations it causes. On the other hand, he presence of -supernumerary - pectoral muscles is not common and its physiological, clinical or surgical importance will depend on the stage of its development. The important aspect is that these muscles, while crossing the anterior wall of the axila and inserting in the humerus, may confuse or difficult surgical access to the content of the axillary fossa. Pectoralis tertius muscles were found in two dissected cadavers at the Topographic Anatomy of the Faculty of Medicine of the Universidad de La Frontera, Chile. These muscles were bilateral and independent of the pectoralis major muscle. They originated in the external face of the sixth rib and adjacent regions, and inserted in the coracoid process, the crest of the greater tubercle of the humerus, or next to the insertion of the pectoralis major muscle, contributing to the formation of the anterior wall of the axila. The supernumerary muscles crossing the axillary region, whether in an arched form or elongated as the pectoralis tertius muscles, may confuse the surgeon at the entrance of the axila. In view of the above, it is always necessary to consider the possible existence of this type of anatomical variation.

La variación del músculo pectoral mayor es frecuente, siendo la agenesia de este músculo causante de alteraciones morfofuncionales. Por otro lado, la presencia de un músculo pectoral supernumerario no es común y su importancia fisiológica, clínica o quirúrgica va a depender del estado de su desarrollo. Los importancia de estos músculos radica en que ellos cruzan la pared anterior de la axila y se insertan en el húmero, lo que puede confundir o dificultar el acceso quirúrgico al contenido de la fosa axilar. Músculos pectorales terceros fueron encontrados en dos cadáveres disecados en la Facultad de Medicina de Universidad de La Frontera, Chile. Estos músculos eran bilaterales e independientes del músculo pectoral mayor. Ellos se originaban en la cara externa de la sexta costilla y regiones adyacentes y se insertaban en el proceso coracoides, cresta del tubérculo mayor del húmero o próximo a la inserción del músculo pectoral mayor, contribuyendo a la formación de la pared anterior de la axila. Los músculos supernumerarios que cruzan la región axilar, ya sea en una forma arqueada o alargada como los músculos pectorales terceros, pueden confundir al cirujano en la entrada a la axila. En vista de lo anterior, siempre es necesario considerar la posible existencia de este tipo de variaciones anatómicas.

Unilateral pectoralis minimus muscle: a case report / Músculo pectoralis minimus unilateral: reporte de caso

Presence of additional muscles in the pectoral region has often been reported. We report about the presence of Pectoralis Minimus muscle, in a male cadaver. It was present deep to the pectoralis major muscle and superomedial to the pectoralis minor muscle. The variant was closely related to the branches of thoracoacromial vessels where one of the branches was passing between the pectoralis minor muscle and the variant muscle. Hyperabduction of the arm may compress these vessels giving rise to certain vascular symptoms. Also these variations should be borne in mind during certain surgical procedures in the pectoral region

Presencia de músculos supernumerarios en la región pectoral han sido reportados. En un cadáver de un hombre se describe la presencia de un músculo Pectoralis Minimus. El músculo se localizaba profundo al músculo pectoral mayor y superomedial al músculo pectoral menor. La variación se relacionaba con las ramas de los vasos toracoacromiales donde una de las ramas pasaba entre el músculo pectoral menor y la variación muscular. La hiperabducción del brazo puede comprimir estos vasos provocando síntomas vasculares. Estas variaciones se deben tener en cuenta durante los procedimientos quirúrgicos en la región pectoral